Indicator Of Function In Patients Research Articles

#485 Studying the features of heart remodeling processes depending on the degree of renal dysfunction

Abstract Background and Aims Chronic kidney disease (CKD) and heart failure (HF) affect many people worldwide and both diseases remain associated with considerable morbidity and mortality. Aim of the study was to features of changes in cardiac remodelling parameters depending on the degree of kidney dysfunction. Method A comprehensive examination of 105 patients with coronary heart disease (CHD) with functional class I-III and chronic heart failure (CHF) was carried out, assessing the clinical condition, exercise tolerance, left ventricular remodelling processes, and the functional state of the kidneys. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n=51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n=54) The average age of patients in group I was 58.77 ± 0.94 years, in group II 61.3±0.68 years and 62.14 ± 0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n = 51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n = 54) The average age of patients in group I was 58.77±0.94 years, in group II 61.3 ± 0.68 years and 62.14±0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years. Results The progression of the severity of CHF with eGFR ≤60 ml/min/1.73 m2 was accompanied by an increase in LV volume parameters, pronounced structural changes, as well as a pronounced degree of LV dilatation. At the same time, in the group of patients with FC III CHF, there was an increase in ESR by 26.8% (p < 0.001) and EDV by 10.64% (p < 0.01) in relation to the data of group I with FC I CHF. Analysis of the parameters of LV systolic function (SV and EF), as well as fractional shortening of the LV in systole, showed that in group II there was a significant decrease in LVEF, SV and Fs% in patients with class II CHF by 10.7%, 14.4% and by 9.0% (p > 0.05) in relation to the data of CHF I FC. In patients with FC III CHF, there was also a pronounced decrease in EF by 28.8% (p < 0.01) and Fs% by 31.75% (p < 0.001) in relation to the FC I CHF data. Analysis of diastolic function indicators in patients with CHF with GFR ≤60 ml/min. Severe disturbances in LV diastolic function are observed in the group of patients with FC II CHF, where there is an increase in the maximum rate of late atrial filling (RA) by 25.1% (p < 0.001) and a significant decrease in the maximum rate of early filling of the left ventricle (PE) compared to study group I by 12.6% (p > 0.05). Conclusion The results of the analysis of indicators of the sizes of the LV and LA cavities, as well as the LV walls, established the peculiarity of structural and geometric changes in the left parts of the heart in patients with FC I-III CHF (increase in LVMM by 10.25%; p < 0.001) in relation to data with eGFR>60 ml/min/1.73 m2. A decrease in the level of LVEF in patients with eGFR ≤60 ml/min/1.73 m2 is evidence of the role of the severity of DP in reducing systolic function in patients with CHF (EF by 25.4% and Fs% by 11.2% (p < 0.001)). 2. Analysis of diastolic function indicators in patients of group II with eGFR ≤60 ml/min/1.73 m2 showed an increase in the maximum rate of early left ventricular filling (PE) by 13.25% (p < 0.001), which led to an increase in E/ and by 20.5% in patients with CHF eGFR ≤60 ml/min/1.73 m2 compared to CHF with eGFR>60 ml/min/1.73 m2 (p < 0.001).

Hypercapnic hypoxia as a rehabilitation method for patients after ischemic stroke

ABSTRACT Introduction Experimental studies on animals have demonstrated a higher neuroprotective efficacy of hypercapnic hypoxia compared to normocapnic hypoxia. Respiratory training with hypercapnic hypoxia has shown a positive impact on the functional state of the nervous system in children with cerebral palsy (CP). It can be presumed that the combined effect of moderate hypercapnia and hypoxia will be promising for clinical application within the context of early rehabilitation after ischemic stroke. Methods A randomized triple-blind placebo-controlled study was conducted on 102 patients with ischemic stroke, aged 63.07 ± 12.1 years. All patients were diagnosed with ischemic stroke based on neuroimaging criteria and/or clinical criteria within the 48–72 hour timeframe. The experimental group (n = 50) underwent daily respiratory training with hypercapnic hypoxia (FetCO2 5–6%, FetO2 15–16%) using the ‘Carbonic’ device for 7–11 sessions of 20 minutes each day during the treatment process. The control group (placebo, n = 52) underwent training on a similar device modified for breathing atmospheric air. Neurological examinations were conducted on all patients before the study and on the day after completing the training course. Results The standard treatment demonstrated effectiveness in terms of neurological status scales in both groups. Intermittent exposure to hypercapnic hypoxia proved more effective in improving neurological function indicators in patients compared to the placebo group: NIHSS scale scores were 40% lower than in the placebo group (p < 0.001); mRS scale scores were 35% lower (p < 0.001); B-ADL-I and RMI indices were higher by 26% (p < 0.01) and 36% (p < 0.001), respectively; MoCA scale results were 13% higher (p < 0.05); HADS and BDI-II scale scores were lower by 35% (p < 0.05) and 25% (p < 0.05), respectively. The increase in MMSE scale scores in the intervention group was 54% higher (p < 0.001), and MoCA scale scores increased by 25% (p < 0.001). Conclusion Respiratory training with hypercapnic hypoxia improves the functional state of the nervous system in patients with ischemic stroke. After conducting further clarifying studies, hypercapnic hypoxia can be considered as an effective method of neurorehabilitation, which can be used as early as 48–72 hours after the onset of stroke.

Dynamics of ventilation parameters in patients with bilateral destructive tuberculosis after staged surgical treatment using extrapleural pneumolysis with silicone plombage.

AimTo study the dynamics of respiratory function indicators in patients with bilateral widespread destructive tuberculosis during staged surgeryt using extrapleural pneumolysis with silicone plombageon the side of the smallest lesion&#x0D; Material and methods.The main group consisted of 14 patients with widespread bilateral destructive tuberculosis who underwent extrapleural pneumolysis with silicone plombage (ESP) in combination with lung resection on the opposite side. The control group included 29 patients who underwent lung resection operations on both sides. All patients underwent spirometry before and 3-5 weeks after each stage of surgery: FVC (functional vital capacity of the lungs) and FEV1 (volume of forced exhalation in 1 second) were determined.&#x0D; Results.The dynamics of the spirometric study after staged surgery in the ESP group was a decrease in FVC by 1.050.47, FEV1 by 0.950.6 l, and in the comparison group by 1.740.76 l and 1.330.5 l, respectively (p0.05).&#x0D; Conclusion.Staged surgery with the use of ESP is accompanied by a significantly smaller decrease in functional parameters and can be used in patients with widespread bilateral destructive tuberculosis with low respiratory function.

Dynamics of respiratory indicators in patients with bilateral destructive tuberculosis after surgical treatment using staged bilateral extrapleural pneumolysis with silicone plombage

Introduce. Patients with a high prevalence of the process and extensive destruction of the pulmonary parenchyma have reduced lung reserves, which limits the use of resection interventions.Objective. To study the dynamics of respiratory function indicators in patients with bilateral widespread destructive tuberculosis during surgical treatment using staged bilateral extrapleural pneumolysis with silicone plombage (ESP).Object and methods. The main group consisted of 11 patients who underwent surgical treatment using staged bilateral ESP. The comparison group included 8 patients with bilateral widespread destructive pulmonary tuberculosis who underwent consecutive bilateral lung resections with a volume of more than 3 segments. The dynamics of respiratory function indicators were studied 3–5 weeks after surgery.Results. In the main group, after stage-by-stage surgical treatment, the FVC index decreased by 0.9 ± 0.6 liters, while in the comparison group by 1.3 ± 0.7 liters (p &lt; 0.01). The index of FEV1 in patients of the main group decreased by 0.5 ± 0.5 liters, and in the comparison group by1 ± 0.3 liters (p &lt; 0.01).Conclusion. Staged surgical treatment with the use of bilateral ESP is accompanied by a significantly smaller decrease in functional parameters and can be used in patients with widespread bilateral destructive tuberculosis with low respiratory function.

Arsenic exposure and lung function decline in chronic obstructive pulmonary disease patients: The mediating influence of systematic inflammation and oxidative stress

Lung tissue is one of the target sites of arsenic (As). The goal of this investigation was to assess the associations of blood As concentration with pulmonary function indicators in patients with chronic obstructive pulmonary disease (COPD), as well as the roles of systemic inflammation and oxidative stress in this relationship. All 791 COPD patients were selected. Blood As concentration, and tumour necrosis factor-α (TNF-α) and 8-iso-prostaglandin-F2α (8-iso-PGF2α) were detected in the serum of COPD cases. Blood As was robustly related to pulmonary function parameters in an inverse dose-dependent manner. Multivariate linear regression analyses verified that a 1-unit increase of blood As was linked to declines of 0.263 L in FVC, 0.288 L in FEV1, 3.454 in FEV1/FVC%, and 0.538 in predicted FEV1%, respectively. The potential for pulmonary function decline gradually increased across the elevated tertiles of blood As. Nonsmokers were susceptible to As-induced pulmonary function reduction. Blood As was positively linked to the levels of TNF-α and 8-iso-PGF2α. Increased TNF-α and 8-iso-PGF2α partially mediated As-induced the reductions in FEV1 and FVC among COPD patients. As exposure is intensely linked to pulmonary function reduction. Systematic inflammation and oxidative stress partially mediate such associations in COPD patients.

Risk Factors for Abnormal Small Airway Function Indicators in Nasal Polyp Patients with and without Asthma

Introduction: Small airway dysfunction (SAD) is associated with type 2 inflammation in patients who have non-asthmatic chronic rhinosinusitis with nasal polyps (CRSwNPs); however, the risk factors for abnormal small airway function indicators in CRSwNP patients with and without asthma remain unclear. Methods: We retrospectively analyzed 41 asthmatic and 109 non-asthmatic CRSwNP patients. Clinical characteristics were compared between groups, correlations between small airway function and clinical parameters were calculated, and independent risk factors for every small airway indicator were identified in each group. Results: Asthmatic CRSwNP patients had significantly reduced small airway function, and the proportion of patients with SAD was higher in asthmatic CRSwNP patients (65.85%) than in patients without asthma (9.17%). With regard to specific airway function indicators, age and a patient’s blood eosinophil (%) were identified as independent risk factors for lower FEF_50% %pred and FEF_25–75% pred, with age being an independent risk factor for FEF_75% %pred in asthmatic CRSwNP patients. In non-asthmatic CRSwNP patients, allergic rhinitis comorbidity was found to be an independent risk factor for FEF_50% %pred, FEF_75% %pred, and FEF_25–75% %pred. Conclusion: Physicians should pay greater attention to risk factors for abnormal small airway function indicators in patients with CRSwNPs to prevent the occurrence of SAD.

Dynamics of indicators of motor functions on the background of physical rehabilitation in children of early age with epilepsy and motor disorders

Epilepsy is a chronic brain disease and one of the most common neurological diseases in the world, manifested by sudden seizures due to increased paroxysmal activity of neurons. There are no published studies aimed at assessing the dynamics of motor development in young children suffering from epilepsy with motor disorders.Purpose. The paper aimed at studying the dynamics of motor function indicators in patients with epilepsy on the background of movement disorders during three courses of rehabilitation treatment.Material and methods. We studied 123 young children with epilepsy and motor disorders. Age ranged from 9 months to 24 months. All patients were divided into 3 groups: group 1 patients who received only general massage, group 2: patients who received Vojta therapy, group 3: patients who received massage and Vojta therapy. The duration of remission for clinical seizures in all groups was at least 3 months, remission for video EEG monitoring in all patients was 23 months. Three courses of medical rehabilitation were carried out with an interval of 2 to 5 months for 1015 sessions of 2530 minutes daily. The dynamics of motor development of patients and the effectiveness of medical rehabilitation were assessed using the GMFCS scale, before and after each course of medical rehabilitation.Results. After the first course of rehabilitation, almost no improvement was observed and was unreliable, while after the second course there was a significant positive trend, especially pronounced in group 3. At the same time, the growth of the scale indicators in the period from the end of the first course to the end of the third was almost linear.Conclusion. The data obtained indicate the presence of a certain rigidity of the motor system of such patients, which determines the minimum dynamics after the first course of rehabilitation. Only starting from the second course, we begin to notice a linear improvement in the indicators of motor functions. The preferred duration of the interval between courses, in our opinion, is not less than two and not more than three months.

Dynamics of liver function indicators in patients with COVID-19

Dynamics of liver function indicators in patients with COVID-19

Liver function indicators in patients with breast cancer before and after detection of hepatic metastases-a retrospective study.

Liver metastases are common in patients with breast cancer, and determining the factors associated with such metastases may improve both their early detection and treatment. Given that liver function protein level changes in these patients have not been determined, the aim of our study was to investigate liver function protein level changes over time, spanning 6 months before the detection of liver metastasis to 12 months after. We retrospectively studied 104 patients with hepatic metastasis from breast cancer who were treated at the Departments of Internal Medicine I and the Department of Obstetrics and Gynecology at the Medical University of Vienna between 1980 and 2019. Data were extracted from patient records. Aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, lactate dehydrogenase and alkaline phosphatase were significantly elevated when compared to normal range 6 months before the detection of liver metastases (p<0.001) Albumin was decreased (p<0.001). The values of aspartate aminotransferase, gamma-glutamyltransferase, and lactate dehydrogenase were significantly increased at the time of diagnosis compared to 6 months prior (p<0.001). Patient- and tumor-specific parameters had no influence on these liver function indicators. Elevated aspartate aminotransferase (p = 0.002) and reduced albumin (p = 0.002) levels at the time of diagnosis were associated with shorter overall survival. Liver function protein levels should be considered as potential indicators when screening for liver metastasis in patients with breast cancer. With the new treatment options available, it could lead to prolonged life.

Changes of Oral Flora, Inflammatory Factors, and Immune Function Indicators in Patients with Chronic Periodontitis and Their Clinical Significance.

This research focuses on investigating the changes of oral flora, inflammatory factors, and immune function indicators in patients with chronic periodontitis (CP) and their clinical significances. Clinical indices such as gingival index (GI) and sulcus bleeding index (SBI) of the study subjects were recorded. The levels of oral flora, inflammatory factors and T lymphocyte subsets in gingival crevicular fluid (GCF) of the study subjects were measured. To analyze the correlation between GI and gingival SBI and oral flora, inflammatory factors, and immune function indicators, Pearson correlation analysis was performed. Porphyromonas gingivalis, Streptococcus digestiveis, Prevotella intermedia, Veronococcus, tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), IL-8, CD3+, CD4+, and CD4+/CD8+ had a positive correlation with GI and SBI, while IL-10 and CD8+ were negatively correlated with GI and SBI. Oral flora, inflammatory factors and immune function indicators levels are largely elevated in patients with CP and they are correlated with CP clinical indicators.

Concurrent administration of amiodarone and atenolol in the treatment of coronary artery disease complicated with arrhythmia, and its effect on serum levels of CD40L, TNF-α and IL-6

Purpose: To investigate the efficacy of the combination of amiodarone and atenolol in the treatment of patients with coronary artery disease (CAD) complicated with arrhythmia, and its effect on serum levels of CD-40L, TNF-α and IL-6.Methods: One hundred and twenty CAD patients with arrhythmia on admission in The First People'sHospital of Shuangliu District Chengdu, China were assigned to groups A and B, each having 60 patients. Amiodarone was administered to all the patients, while atenolol was additionally given to patients in group A. Levels of heart function indicators, inflammatory factors, blood pressure, heart rate, adverse reaction rate (ARR) and overall efficacy were evaluated for the two groups.Results: There were significantly improved levels of heart function indicators, and lower levels of CD40L, TNF-α and IL-6 in group A, when compared with group B (p &lt; 0.001). Moreover, treatment effectiveness was higher in group A than in group B (p &lt; 0.05). However, there was no significant difference (p &gt; 0.05) in ARR between groups A and B.Conclusion: The combined use of amiodarone and atenolol improves heart function indicators in patients with CAD and arrhythmia, reduces the levels of inflammatory factors, normalizes blood pressure and heart rate, and lowers ARR. However, further clinical trials on this combined therapy are required prior to its use in clinical practice.

Predicting the response of the lung function in patients with chronic obstructive pulmonary disease under the influence of climate-technogenic factors

Introduction. Lung function plays an important role in the adaptation to environmental conditions. Therefore, the study of the processes of influence of climatic and technogenic factors on the human respiratory organs is an urgent problem of our time.Aim. To predict the dynamics of lung function indicators in patients with chronic obstructive pulmonary disease (COPD) under the influence of changes in the qualitative state of the climatic and technogenic environment of Vladivostok.Materials and methods. 177 people were examined: of them 45 patients with mild COPD, 50 with moderate COPD, 45 with severe COPD, 37 healthy volunteers were included in the control group. The study of the lung function was carried out by the spirometry. For the analysis, we used regression models that assess the activity and intensity of the compensatory and pathogenic response of the lung function indicators to the impact of 28 climatic and technogenic factors of the urban environment.Results. As a result of calculations, Rfunc (at p&lt;0.05) was selected for the impact of 11 trigger factors of the environment. The search for the optimal multiple regression model (Rregr=0.69; F=7.1; p=0.001), which characterized the response of the indicator Yi (FEV1) to the action of Xi (“road density”) and X2 (“air temperature“), was carried out. Substitution of the values Xi, X2 made it possible to form a nomogram of the calculated data (Yi).Conclusion. The difference in the response of lung function to the technogenic and climatic environment made it possible to assess the impact of external factors from the standpoint of its pathogenicity and sanogenic power. According to the obtained regression model, it was found that in Vladivostok, the most favorable external loads are observed at temperatures &gt;5ºC (FEV1&gt;80%), however, at the maximum “road density”, the indicator falls (FEV1≤60%). The resulting nomogram makes it possible to predict the dynamics of the FEV1 in the patients with COPD living in different environmental conditions, depending on the change in air temperature. Timely implementation of medical and preventive measures will reduce the risk of COPD progression in an urban environment.

Effect of arterial oxygen partial pressure inflection point on Venoarterial extracorporeal membrane oxygenation for emergency cardiac support

BackgroundTemporary circulatory support is a bridge between acute circulatory failure and definitive treatment or recovery. Currently, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is considered to be one of the effective circulatory support methods, although cardiac function monitoring during the treatment still needs further investigation. Inflection point of arterial oxygen partial pressure (IPPaO2) may occur at an early stage in part of patients with a good prognosis after VA-ECMO treatment, and the relationship between time of IPPaO2 (tIPPaO2) and recovery of cardiac function or prognosis remains unclear.MethodsTo investigate this relationship, we retrospectively analyzed the clinical data of 71 patients with different conditions after treatment with VA-ECMO in the emergency center of Jiangsu Province Hospital between May 2015 and July 2020. Spearman’s correlation analysis was used for the correlation between tIPPaO2 and quantitative data, and ROC curve for the predictive effect of tIPPaO2 on the 28-day mortality.ResultsThirty-five patients were admitted because of refractory cardiogenic shock (26 of 35 survived) and the remaining 36 patients due to cardiac arrest (13 of 36 survived). The overall survival rate was 54.9% (39 of 71 survived). Acute physiology and chronic health evaluation II, ECMO time, tIPPaO2, continuous renal replacement therapy time, mechanical ventilation time, and bleeding complications in the survival group were lower than those in the non-survival group, with length of stay, intensive care unit stay, and platelet levels were being higher. The tIPPaO2 was negatively correlated with ejection fraction, and the shorter tIPPaO2 resulted in a higher 28-day survival probability, higher predictive value for acute myocardial infarction and fulminant myocarditis.ConclusionsTherefore, tIPPaO2 could be a reliable qualitative indicator of cardiac function in patients treated with VA-ECMO, which can reveal appropriate timing for adjusting VA-ECMO flow or weaning.Trial registrationChiCTR1900026105.

Pathogenetic rationale for the use of intermittent normobaric hypoxytherapy in the rehabilitation of patients with chronic obstructive pulmonary disease

Objective — to determine affects of the intermittent normobaric hypoxytherapy on the dynamics of general non‑specific adaptive reactions in the complex rehabilitation of patients with chronic obstructive pulmonary disease (COPD).&#x0D; Materials and methods. The treatment and examinations involved 450 patients with COPD, including GOLD 2 in 55.56 % (250 people) and GOLD 3 in 44.44 % (200 patients). The mean age was (52.65 ± 14.80) years, proportion of female and male subjects was equal. All patients received basic drug therapy according to the Order of MoH of Ukraine. The disease duration was 10 to 30 years, the remission stage was established in all patients. Patients were randomized into two groups: main (400 people) and control (50 people) with the same COPD severity distribution. Patients of the main group received additional 30 minutes sessions of interval normobaric hypoxytherapy for 20 days. The examination were performed for the dynamics of clinical symptoms, respiratory function, nonspecific resistance of an organism.&#x0D; Results. Most patients had symptoms of the disease against the background of basic COPD medication even on the remission stage. Unfavorable and intense adaptive reactions were determined in 71.33 % of COPD patients, and eustress reactions only in 16.89 %. Sanogenetic types of adaptive reactions were found in 28.45 % of subjects, maladaptive types — in 21.78 % of persons, pathogenetic — in 63.33 % of patients. At GOLD 2, tense reactions were diagnosed in 69.6 % of subjects, and in GOLD 3 in 73.0 %. As the severity of the disease increased, there was an increase in the development of intense training and activation responses. Upon completion of the course of hypoxytherapy, the exercise tolerance increased, and shortness of breath appeared only after severe physical activity in 90.25 % of patients in the main group, whereas in the control group similar changes were observed only in 20.0 % of patients. The respiratory function indicators in patients of the main group increased on average by 17.52 %, while in the control group — by 3.3 %.&#x0D; In the main group, favorable adaptation reactions prevailed in 88.25 % of patients, while in the control group this indicator was 32.0 %. The percentage of adverse reactions in the main group decreased significantly and was 11.75 % after treatment, the proportion of stress reactions — 46.25 %. In GOLD 2, the proportion of pathogenetic reactions decreased to 17.33 % and 56.00 % of the main and control groups, and in GOLD 3 — in 20.44 % and 44.0 %, respectively (p &lt; 0.05).&#x0D; Conclusions. The use of a course of normobaric hypoxytherapy promoted the reduction of the main clinical COPD symptoms, increase of the frequency of favorable adaptive reactions up to 88.25 %, it raised clinical effectiveness of the treatment, which allowed to avoid disease exacerbations during the year in 80.95 % of patients.&#x0D;

Prognostic nutritional index is related to myocardial performance index in newly diagnosed nondiabetic hypertensive patients

ABSTRACT Background: Arterial hypertension (AH) leads to systolic and/or diastolic dysfunction of the left ventricle (LV) by causing structural changes in the myocardium. Myocardial performance index (MPI) provides the evaluation of LV systolic and diastolic functions together. Prognostic nutritional index (PNI) is an indicator of immunonutritional status. PNI was studied in patients with malignancy, malnutrition, and cardiovascular diseases so far. It was aimed to investigate the relationship between PNI and MPI in hypertensive patients. Methods: A total of 91 consecutive patients with newly diagnosed AH were included in the study. PNI was calculated according to the following formula: ((10 × serum albumin (g/dL))+(0.005 × total lymphocyte count)). MPI was obtained by dividing the sum of isovolumetric relaxation time (IVRT) and isovolumetric contraction time (IVCT) by the ejection time (ET) ((IVRT+IVCT)/ET). Patients were divided into two groups according to MPI is above or below the value of 0.5. The demographic characteristics and PNI values of patients were compared between two groups. Results: There were 65 patients in the higher and 26 patients were in the normal MPI group. Higher MPI group had male predominance (p = .002). Diastolic blood pressure (p = .021), interventricular septum thickness (p = .005), posterior wall thickness (PWT) (p = .001), serum albumin concentration (p = .045), and PNI (p = .013) were differed between groups. Multivariate logistic regression analysis revealed that PWT [OR = 1.835, 95% CI: 1.126–2.992, p = .015] and PNI [OR = 1.161, 95% CI: 1.004–1.343, p = .018] predicted higher MPI. Conclusion: Higher PNI was an independent predictor of LV dysfunction in newly diagnosed hypertensive patients. Immunonutritional status may be used as an indicator of the left ventricular function in patients with AH.

Endothelial function indicators in patients with critical limb ischemia compared to patients with limb claudication – one-year follow-up period after endovascular revascularisation

Abstract Background Critical limb ischemia (CLI) is the most advanced stage of peripheral arterial disease. Limb revascularization is considered the first line of treatment. Purpose The aim of the study was to compare endothelial function and clinical outcomes in CLI and non-CLI patients during a 12-month follow-up period after endovascular treatment (PTA). Methods The study was conducted as a prospective, single-centre, follow-up evaluation. The authors recruited 30 CLI and 40 non-CLI patients. The following markers of endothelial dysfunction were evaluated: flow-mediated dilatation (FMD), reactive-hyperaemia index (RHI), arterial pulse-waveform analysis (aPWA) indices and clinical markers such as ankle-brachial index, toe-brachial index and Rutherford scale. Results Better clinical improvement may be observed in patients with CLI - the mean Rutherford grade significantly decreased in the CLI group (p&amp;lt;0.001). These patients also have better endothelial response to revascularization – CLI patients continue to have improved RHI up to 6 months after PTA, where in non-CLI patients, improvement was only noted during the first month. The mean FMD value did not change significantly during the follow-up in either of the groups. When comparing selected intervals, the FMD values in the CLI and non-CLI groups improved during the first month of observation and then decreased between the 1st and 6th month of follow-up. Finally, in CLI patients, baseline intima-media thickness predicts the number of reinterventions and major adverse events. Conclusions Patients with CLI differ significantly from patients with claudication based on clinical response and endothelial changes after revascularization. Figure 1. A) Kaplan-Meier survival curves according to CLI and non-CLI status for all study endpoints. B) Kaplan-Meier survival curves according to CLI and non-CLI status for reinterventions. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Collegium Medicum of Jagiellonian University - internal grant

Bendopnea and Its Clinical Importance in Outpatient Patients with Pulmonary Arterial Hypertension.

Bendopnea is a recently reported novel symptom in patients with heart failure (HF) defined as shortness of breath when bending forward. It has been demonstrated that bendopnea is associated with advanced symptoms and worse outcomes. The aim of this study was to assess the presence of bendopnea and its clinical importance with regards to functional status, hemodynamic and echocardiographic characteristics in outpatient pulmonary arterial hypertension (PAH) patients. We conducted this prospective observational study of 53 patients who were admitted to our PAH clinic for routine control visits. We determined the presence of bendopnea and analyzed hemodynamic parameters, World Heart Organization (WHO) functional class, transcutaneous oxygen saturation, 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP) and right ventricular (RV) function indicators in patients with and without bendopnea. Bendopnea was present 33.9% of the PAH patients. The mean age was higher in the patients with bendopnea than in those without bendopnea, but the difference was not significant (p = 0.201). The patients with bendopnea had a lower 6-MWD and higher NT-proBNP level (p < 0.001), and worse WHO functional class symptoms (p = 0.010). Mean right atrial pressure, pulmonary artery pressure, and pulmonary vascular resistance were higher in the patients with bendopnea. The patients with bendopnea had a more dilated RV end-diastolic diameter and lower tricuspid annular plane systolic excursion value (p < 0.001 and p = 0.001, respectively). Bendopnea was associated with worse functional capacity status, hemodynamic characteristics and RV function in our outpatient PAH patients.

PROGNOSTIC VALUE OF KIDNEY FUNCTION PARAMETERS IN PATIENTS WITH CHRONIC HEART FAILURE AND LEFT VENTRICULAR REDUCED EJECTION FRACTION

Chronic heart failure (CHF) is a complex clinical syndrome characterized by progressive course, unsatisfactory quality of life, poor prognosis and high incidence of concomitant renal dysfunction (RD). The aim of our work was to study the prognostic value of a number of renal function indicators in patients with CHF and a reduced left ventricular ejection fraction (LVEF). Materials and methods. 134 patients with stable CHF and reduced (&lt;40 %) LVEF, II-IVNYHA class were examined. Patients were divided into two groups according to the level of GFR: the first group of GFR&lt;60 ml/min./1.73 m², the second – GFR≥60 ml/min./1.73 m². The average follow-up period was 13.4 months, the maximum was 27.5 months. Results. In 53 patients RD was detected (glomerular filtration rate was ˂60 ml/min/1.73 m²), which was 39.5 %. Patients of both groups did not differ in their main hemodynamic parameters, left ventricular ejection fraction, and pharmacotherapy structure, but were older in age and heavier clinically. After the analysis of survival curves of patients depending on GFR, a group of patients with RD had a significantly worse survival prognosis compared to a group without RD. After adjusting the groups by age and NYHA class, the indicated difference was maintained. The subjects were divided according to median levels: blood urea nitrogen, blood urea nitrogen / creatinine ratio, microalbuminuria, albumin / creatinine ratio in urine. The long-term survival of the formed groups was analyzed. The level of blood urea nitrogen did not significantly influence the prognosis of patients with CHF and reduced LVEF. At the same time, when the groups were divided, depending on the median value of the blood urea nitrogen / creatinine ratio, there was a significantly higher risk of fatal outcome in the group with lower indices. The level of MAU did not significantly affect the survival of patients. In addition, a comparison of the survival of patients with higher and lower values of the albumin / creatinine ratio in the urine revealed a significantly higher risk of death in patients with higher values. Conclusions: 1. The presence of RD (GFR˂60 ml/min/1.73 m²) is observed in 39.5 % of patients with CHF and reduced LVEF and is associated with their worst long-term survival. 2. The BUN and MAU do not have sufficient predictive information about the forecast of long-term survival of the above category of patients. 3. At the same time, the values of the BUN/ Сreatinine ratio ˂24.5 and the ACR ˃12.7 indicate patients with CHF who have a higher long-term risk of death.

DYSUNCTION OF RESPIRATORY SYSTEM IN PATIENTS WITH CORONARY ARTERY DISEASE AFTER PLANNED CORONARY ARTERY BYPASS GRAFTING

The purpose. Analysis of the dynamics of respiratory function indicators in patients with coronary artery disease (CAD) and comorbid bronchopulmonary pathology (BPP) who underwent coronary artery bypass grafting under cardiopulmonary bypass (CB). Materials and methods. We examined 662 patients with CAD admitted for planned CABG. The formation of groups was based on the presence criteria of BPP and broncho-obstructive type of ventilatory disorders. Group 1 included 48 (7.2%) patients with BPP without obstructive disorders, group 2 – 248 (37.5%) patients with BPP who have respiratory obstruction, group 3 – 366 (55.3%) patients with the isolated CAD. The analysis of the dynamics of respiratory system function was based on the deviation from the due values as well as on the deviation of recoded respiratory parameters, which form the basis of comprehensive assessment of respiratory function. Results. In the postoperative periodall the patients showed a decrease of all respiratory parameters. Statistically lower parameters were observed in patients who had broncho-obstructive syndrome. To a greater extent (for more than 15% from the baseline) we registered a decrease in forced and slow vital lung capacity, total lung capacity, forced expiratory volume in 1 second, as well as diffusing capacity, to a lesser extent –intrathoracic and residual volumes. When comparing the similar respiratory parameters, basing on their recoding, statistically marked decrease was observed in patients who had a respiratory disease (the 1st and the 2nd groups) as compared to the patients with isolated CAD. Conclusion. After CABG under CB there was a decrease of all the indicators which characterize pulmonary function, a more pronounced decrease was noticed in the level of forced and slow vital lung capacity and forced expiratory volume in 1 second. Interpretation of the dynamic changes of the recoded indicators showed an advantage over the traditional analysis based on the deviation from the due values.

Estimación de la tasa de filtración glomerular en personas con y sin síndrome metabólico

Introduction: Metabolic syndrome (MS) is an independent risk factor, which affects the development of chronic kidney disease, so the glomerular filtration rate (GFR) as an indicator of glomerular function in patients with and without MS who attended the outpatient clinic “los Grillitos, sector Caña de Azucar”. Materials and Methods: A comparative, correlational, cross-sectional study was conducted in a non-probability sample of convenience consisting of 60 patients with MS diagnosed according to the criteria Panel ATP III, and 60 apparently healthy individuals, whom the GFR was determined by the Cockcroft-Gault as well as clinical and biochemical parameters for the diagnosis of MS. Results: Out of the total patients evaluated, 37 (30.7%) showed alterations that put them in grades G2 and G3 system risk stratification of CKD, of these 18 and 19 corresponded to patients with and without MS respectively. Glomerular Hyperfiltration (&gt; 120 mil / min) it was found in both groups 28 (46.7%) and 24 (40%) cases of patients with and without MS respectively. The glomerular function was strongly correlated with abdominal obesity and high levels of stress arterial. As for the number of criteria and its relationship to the level of kidney damage present, not a firm to increase the latter with respect to the first (p=0.385) trend was observed. Conclusion: The change in the glomerular function is not directly related to the MS but with its components, specifically abdominal obesity and hypertension.